Tag: Organ donation

The Swiss bishops are opposed to presumed consent for organ donation. “We are not against organ donation […]. But we do not want it to be automatic,” said Bishop Felix Gmür, president of the Swiss Bishops’ Conference (Conférence des évêques suisses, CES), at a press conference in Bern on Thursday.

A popular initiative entitled Promote Organ Donation – Save Lives to introduce presumed consent in Switzerland has been under consideration since spring. It is intended to “facilitate donations” and “reduce waiting lists”. The bishops oppose this proposal because “a donation presupposes the expressly voluntary nature of being a donor”. Presumed consent “is contrary to the principle of explicit consent by the person concerned”. The bishops believe that organ donation can be considered an act of love, but “that it cannot give rise to any moral obligation. Anyone who does not want to give their organs, tissues or cells can under no circumstances be morally condemned”.

Tribune de Genève (06/06/2019) – Don d’organes: les évêques rejettent le consentement présumé

According to Matthew Bacchetta’s team at Columbia University, a new technique can apparently regenerate lungs considered too damaged to be transplanted, which represent 80% of the lungs removed from donors. Their study published in Nature Communications shows that a cross-circulation technique enables lungs to be kept outside the body for 36 hours, giving doctors time to “rehabilitate” them. Currently, doctors have 6 hours between removal and transplantation. Bacchetta wants to extend the survival time of organs outside the body to “several days or even weeks”. This “organ recovery” could be used for other organs, such as the heart, kidneys and liver. However, further studies are needed to confirm the viability of ‘regenerated’ organs, the safety of the method and the response of lungs to immunosuppressants administered after transplantation.

Medical press (7/05/2019)

One year after his operation, Maurice Desjardins, the first Canadian to receive a face transplant, has recounted his experience. His entire face – nose, jaw, teeth, facial muscles and skin – was transplanted under the supervision of plastic surgeon Dr Daniel Borsuk at Maisonneuve-Rosemont Hospital in Montreal. It was a “high-risk” operation.

Although the worst has been avoided – “there has been no rejection” – Maurice is still on anti-rejection treatment that has “made him vulnerable to the slightest infection“. In the space of a year, he has had to fight off three major infections and spent a total of ten weeks in hospital. After being forced to break off his exercises to regain full use of his face for a few months, his jaw no longer closes and he cannot express himself clearly. “Maurice is going to do his exercises and this will improve,” said Dr Borsuk. Fed through a tube or with crushed food, Maurice has lost nearly 30 kilos. His wife, who cares for him on a permanent basis, says she has to “remain very attentive. It really is a 24-hour-a-day job! That’s why I didn’t have a choice. I had to quit my job,” she explained.

Despite these many obstacles, Mauritius said he has “no regrets“. When asked if it was worth it, he answered: “Yes. Actually, it’s more than worth it. It’s been priceless. Yes, really priceless”.

Radio Canada, Danny Lemieux (8/05/2019) – Un an passé avec un nouveau visage

Faced with the permanent shortage of organ donors, researchers are looking into alternatives. 3D-bioprinting “to build fully functional organs outside the body” has already begun to prove its worth: for example, to create artificial corneas that can be transplanted into the eye. However, bioprinting requires extensive equipment for culturing and transplanting.

Researchers at the University of Fribourg and the University Hospital of Basel, Switzerland, have developed a new regenerative therapy to “use the body as a manufacturing plant,” thereby eliminating many of bioprinting’s material constraints. The body itself serves as an in-vivo reactor. Already used for bones, this technology has for the first time been tested to produce blood vessels.

Body cells develop in the extracellular matrix (ECM) environment, which contains “vital information that helps cells move, grow and organize themselves into functional tissues”. Some ECM properties can be copied into an injectable hydrogel, which “transmits specific biological information” to the target cells. Researchers use agarose – extracted from an edible red seaweed – as the base to make this hydrogel. Agarose gel is already known in cooking and in biological laboratories, where it is used to separate DNA.

“We have created a unique hydrogel formulation, providing the ideal environment for certain cells to organize themselves into blood vessels,” explained the researchers. They modified agarose “by attaching a small molecule (a peptide) that can interact with the cells. We have shown that this hydrogel injected into muscle can talk to the body and initiate the formation of new blood vessels. Previously, only cartilage and bone could be regenerated in the body like this,” they added.

The researchers thereby hope to pave the way for a new class of therapies, in which injections would contain all the information cells need to “direct their organization into new functional tissues” and in which injected hydrogel “would become just as useful as pharmaceutical drugs”.

The Conversation, Aurelien Forget (28/04/2019)

The United Kingdom has recently adopted the presumed consent system for organ donation (see  United Kingdom and Scotland introduce presumed consent to organ donation). The new law will come into force next year and specifies that a deceased person’s genitals and face will be an exception to presumed consent, which will only apply to ‘routine’ transplants.

The presumed consent system adopted means that everyone over the age of 18 will automatically be registered to donate their organs upon death, unless they objected during their lifetime or unless their family objects. But “the public cannot expect rare or experimental transplants to be included in the system,” said the government, whose priority is “to increase the number of life-saving organ transplants”. The law will therefore not apply to face, limb and genital transplants. However, “if these new transplants become common practice, the government may remove them from the list of organs excluded from presumed consent”.

A consultation, open until 22 July, is giving people in England an opportunity to comment on this amendment to the law and specify which organs and tissues they would like excluded from presumed consent. In addition, the refusal registry will subsequently enable presumed donors to specify which organs they do not wish to donate.

For further reading:

• Presumed consent in England and Scotland? One in ten people refuse to donate their organs

Daily Mail, Alexandra Thompson (1/05/2019)

Under the new law passed today, the thousands of surviving victims of Japan’s forced sterilization program from 1948 to 1996 will each receive 3.2 million yen ($28,700).

About twenty victims have challenged this amount in court, considering it to be insufficient given the extent of their suffering. The first ruling will be issued on 28 May.

Such compensation has previously been implemented in Germany, Sweden, and other countries with similar eugenics laws.

 AFP (24/04/19) 

A German team working on 3D bioprinting of human organs has developed a technique to obtain a “detailed blueprint” of organs to accurately reproduce their structure.

Led by Ali Erturk in Munich, the researchers used a solvent to make the organs transparent. As a result, they could then be scanned to obtain a precise image of their structure and each cell’s location. Using this “blueprint”, the researchers will print a “scaffold” of organs, into which stem cells will be injected to make them functional.

For Erturk, 3D-printed organs have so far lacked detailed cell structures. With his technique “we can see where each cell is located in transparent human organs. And then we can actually replicate exactly the same, using 3D-bioprinting technology to make a real functional organ”.

Over the next two to three years, the team will be focusing its efforts on the pancreas, before developing a kidney in “five or six years’ time”. They will attempt to transplant these bioprinted organs into animals and hope to start in-human trials “within 5 to 10 years”.

Reuters, Ayhan Uyanik (24/04/2019)

On Monday, researchers at Tel Aviv University presented “a vascularized prototype of the human heart, printed in 3D using human tissues”. According to them, this “inert, cherry-sized heart” represents a “breakthrough” in “treating cardiovascular disease and preventing transplant rejection” since it uses a patient’s own cells. In their article published in the scientific journal Advanced Science, the authors explain that they have “designed a process to produce not only hydrogel using cells taken from the patient’s tissue, to form vascularized heart patches perfectly compatible with the recipient, but also entire cell structures such as hearts together with their main blood vessels”. They note, however, that “several difficulties remain” with 3D printing and that transplants in humans are not envisaged for the time being: this “may happen in about ten years”, but animal tests are planned for “within a year”. “What I can imagine is that in 10 years’ time there will be 3D printers in hospitals, that these printers will be printing organs for patients, and that they will probably start doing so with simpler organs than the heart,” said Professor Tal Dvir, who led the research.

For further reading:

• 3D organ printing: research is underway

AFP (15/04/2019)

“The brain’s ability to revive its cells has been underestimated,” said Nenad Sestan, a researcher at Yale University in the USA. He is one of the authors of a study resembling “a science fiction film,” which was published on Wednesday in Nature. The researchers worked on 32 brains of pigs that had been dead for four hours. They irrigated these brains for six hours at 37°C – body temperature – with a special solution “designed to oxygenate tissues and protect them from degradation linked to interrupted blood flow”. The results are impressive: “reduced brain-cell destruction, preserved circulatory functions and even restored synaptic activity”.

The possibility of resuscitation from brain death is still a long way off since the researchers have not identified “any electrical activity that could be the sign of consciousness or perception phenomena”. Nevertheless, although “this is not a living brain”, it is “a celluarly active brain” explained Sestan.

The researchers hope that this discovery could “help improve understanding of the brain” by enabling post-mortem studies, and even pave the way for brain preservation treatment, “after a heart attack, for example”. But the scope of the ethical questions raised is much broader: “It challenges our understanding of what constitutes a living animal or human being,” said scientists commenting on the publication. The study challenges two principles on which there had previously been a consensus: “the fact that neural activity and consciousness permanently stop after blood flow is interrupted in the brain for a few seconds or minutes” and “the fact that unless blood circulation is rapidly restored, an irreversible process is initiated that leads to the death of cells and then the organ”.

A wave of panic is also blowing among organ donation experts: “Most organs are removed from brain-dead donors. If we start considering this state as perhaps reversible, how are we to decide to remove organs? “.  Developing the BrainEx technique – a pump that irrigates the brain by stopping blood flow – could at the very least “harm organ donation” and could also challenge the very principle of organ donation.

For further reading:

Are organ donors really dead?

Disembodied pig brains kept alive artificially for 36 hours

In Switzerland, transplantation legislation changes the conditions for determining death

AFP (17/04/2019)

Photo : Pixabay/DR

The first baby born after a robotic uterine transplant was born in Sweden on Monday 8 April (see Robot-assisted uterine transplants: first pregnancy in Sweden). The baby boy was born at 36 weeks via a scheduled caesarean section; he measured 48 cm and weighed 2.9 kg. The woman was transplanted with her own mother’s uterus in October 2017 as part of the ‘Robot Project’. The donor was operated on using a less invasive technique than traditional open surgery: robots remotely controlled by the surgeons’ joysticks removed the uterus through five 1-cm incisions. This ‘keyhole surgery’ enables a donor to recuperate faster after the operation. The uterus was then transplanted using conventional open surgery. An embryo conceived by IVF before the transplant was transplanted ten months later.

“This is an extremely important step in the development and safety of uterine transplantation surgery. We’re proving for the first time that less invasive robot-assisted surgery is practicable”, said Mats Brännström, professor of obstetrics and gynaecology at the Sahlgrenska Academy, which is pioneering this research on uterine transplants. “In the future, we’re also going to be able to transplant the uterus into the recipient using a robot-assisted keyhole technique”, added Niclas Kvarnström, the surgeon who connected up the blood vessels during this transplant.

This is the ninth Swedish baby born following a uterine transplant, and the first after a robotic transplant. Five other women who received this new type of transplant in 2017 and 2018 are also waiting to become pregnant. In addition, the Sahlgrenska Academy plans to transplant a uterus from a deceased donor.

For further reading:

Uterine transplant from a deceased donor: first baby born in Brazil

Uterus transplants pose the same ethical problems as surrogacy

Medical Press, University of Gothenburg (09/04/2019)

Photo : Pixabay/DR

Researchers in South Korea are expected to transplant pig corneas into humans “within a year”. Several teams in the United States are also preparing to launch clinical trials of xenotransplantation: pig skin transplants on six major burn victims in Boston, and transplants of pig kidneys into adults and pig hearts into newborns in Birmingham (USA). Finally, in Cambridge (USA), the start-up eGenesis is continuing its research to “create pigs whose organs can be safely transplanted into humans” (see eGenesis launches xenotransplantation trial). This objective is shared by other American and European companies.

The first experiments in the 1990s failed due to a rejection reaction within five minutes of transplantation. But in recent years, gene-editing technology has accelerated research to the point that the first clinical trials are now imminent. Using CRISPR, researchers are eliminating genes from the pig genome that cause viruses infectious to humans (see Heading towards organ transplants from genetically modified pigs? To avoid any rejection reaction, they are also working to eliminate markers that identify pig cells as foreign. Recent studies in animals have thus proved more conclusive: baboons with pig hearts have survived 6 months, and even up to 3 years (see Xenotransplantation: baboons survive more than six months with a pig’s heart, Can genetically modified pig hearts counter the organ shortage?). Advances in immunosuppressive treatments could also help support xenotransplantation.

Researchers are not only considering the transplantation of pig organs into humans, but also blood, pancreatic cells to treat diabetic patients, and dopamine-producing cells for patients with Parkinson’s disease.

The Guardian (3/04/2019)

Since a federal law enacted by Barack Obama in 2013, people with AIDS have been allowed to donate their organs to recipients who are also HIV positive upon their death. However, living donations were not allowed, as the donor’s remaining kidney was at risk of being weakened by AIDS treatments.

A study now suggests that this risk is not proven, and in 2016 Johns Hopkins Hospital in Baltimore obtained authorization to perform a kidney transplant between two living persons, both of whom were HIV-positive. The first operation took place last Monday. The donor, age 35, is named Nina Martinez. The identity of the recipient was not disclosed by the hospital. The operation went well and the hospital plans to carry out more.

About 10,000 HIV-positive people are currently on dialysis in the United States, the last stage of kidney failure. Doctors specified that donors must be “healthy” and “have the virus under control”.

For further reading:

In Spain – two patients die after kidney transplants using organs contaminated with herpes

A child receives a liver transplant from an HIV-positive donor

Hepatitis C-infected lungs safe for transplants?

Kidney transplants for patients with severe alcoholic hepatitis more taken into account

AFP, Ivan Couronne (28/03/2019)

On Thursday, a South African medical team announced that it had fitted “transplants of small middle-ear bones [1] made using 3D printing”. This is reportedly “a world first“. The latest operation was performed on Wednesday at Steve Biko Hospital in Pretoria. It involved a “35-year-old patient whose inner ear had been completely damaged in a car accident”.

This operation “may be the answer to conductive hearing loss, a middle-ear problem caused by congenital birth defects, infection, trauma or metabolic diseases,” including in newborns, explained the University of Pretoria. “By replacing only the ossicles that aren’t functioning properly, the procedure carries significantly less risk than known prostheses,” said Professor Mashudu Tshifularo, who has supervised three of these transplants.

1] The middle ear is the part of the auditory system, located between the outer and inner ear. The middle-ear bones are made up of three ossicles: the hammer, anvil and stirrup, which transmit sound vibrations to the inner ear.

AFP (14/03/2019)

On Sunday evening, the UK’s health secretary Matt Hancock appealed for organ donations from young children. Although adult donations have increased by one-fifth since 2004, donations from children “have remained static“. Organs from 57 children resulted in 200 transplants in 2018, almost identical to the 2014 figure, when 55 children donated their organs. According to the National Health Service (NHS), only “half of the families approached after the death of their child gave consent for their organs to be used“.

Speaking to bereaved parents, Matt Hancock said he understood “how difficult it is to consider losing a child, and even more difficult to think about what will happen afterwards. But we must not avoid this subject, which could save lives,” he insisted.

For further reading:

Organ donation: opportunity or expediency?

Instrumentalizing personal stories to increase organ donations?

Teddy, a newborn baby gives his kidneys: the instrumentalization of a courageous but disturbing story

Accompanying anencephalic children…

Anencephalic newborns donate their kidneys: an ethical issue

Daily mail, (4/03/19) – Health officials ask bereaved parents to donate their children’s organs amid warning over drop in donors

The anti-corruption branch of the Federal Investigation Agency (FIA) in Peshawar, Pakistan, has uncovered an inter-provincial network of illegal human-organ transplants, involving hospital officials, doctors and illegal donors. This discovery followed a complaint lodged by a former Mardan government official, Fazle Qadir, against Shoaib Afridi, a dialysis technician at Khyber Teaching Hospital in Peshawar. Qadir had used Afridi’s services and had paid him Rs. 3.1 million for a transplant. 

Shoaib Afridi was arrested by Peshawar’s FIA. During the investigation, he revealed that many experienced surgeons were involved in the network, which also included officials from other provinces. Afridi was working as an intermediary to organize donors, most of whom were destitute and needy, and to hire the surgeons paid to perform transplants. FIA’s anti-corruption director, Mian Saeed, said that further investigations were under way to dismantle the network.

For further reading:

Organ trafficking in China: scientists call for 400 studies to be retracted

Iraq, a ‘hot spot’ for illegal  organ trade in 2018

UN denounces organ trafficking

India – waiting lists to include foreigners in an attempt to curb transplant tourism

The Express Tribune, Umer Farooq  (6/03/2019) – FIA dismantles illegal kidney transplant network

Following in the footsteps of Wales in 2015, Scotland and the United Kingdom are in the process of changing their organ donation schemes to a presumed consent system. The UK House of Lords approved the law on 31 January while in Scotland, the draft law under consideration by the Commission is expected to be discussed in the coming weeks.

Presumed consent assumes that a person consents to organ donation unless indicated otherwise. Advocates of organ donation hope that the new system will encourage people to make their wishes known before they die, as any refusal can be logged in an online registry. However, Professor Chris Rudge, a leading transplant surgeon, opposes this change because “organ donation should be a present and not for the state to assume that they can take my organs without asking me” he said, adding that he is “horribly opposed” to the proposal.

In Scotland, Dr Margaret McCartney also wonders, arguing that “there isn’t any good evidence that would suggest that having this opt-out scheme actually increases the rates of donation […] If you look at what’s happening in Wales, there has been no clear rise in organ donation since the opt-out law was brought in to place in 2015”. She also noted that ” there had been a clear rise in Scotland since 2014/15 in organ donations without this legislation”.

Daily Mail (02/02/2019) ; BBC (01/02/2019)

Between 1999 and 2016, the number of overdose-induced deaths more than tripled in the United States. This impacted on organ transplants with a concomitant rise in the number of organs harvested from overdose victims. 17.6% of organs transplanted in the USA have since been sourced in this way. “This conveys an important message. It shows that people are now accepting organs arising from overdose-related deaths”, says Mandeep Mehra, Medical Director of Brigham’s Heart and Vascular Center. His team analysed data from the Organ Procurement and Transplantation Network, to arrive at the figure of 17.6%. According to their studies, on average 6.24 hearts per 1,000 overdose-related deaths are successfully harvested. “We must look for ways of overcoming this crisis and, at the same time, investigate new ways of increasing the availability of good donor organs.

For further reading:

Overdose-death organ donors: what exactly is the risk?

Medical Press, Brigham and Women’s Hospital (06/02/2019) – Study reveals patterns of drug intoxication deaths, organ donors across the US

A group of Australian researchers has requested the retraction of more than 400 scientific articles following the publication in the journal BMJ Open of work revealing that countless human organs have been harvested unethically from Chinese prisoners in recent decades. 

The study reviewed scientific research documents published from January 2000 to April 2017 comprising 445 studies involving 85,477 transplants. 92.5% of these studies failed to indicate whether the organs were harvested from executed prisoners and 99% failed to indicate whether donors had consented to the transplant. The researchers denounce the lack of information on the reality of organ donation in China. “There’s no real pressure from research leaders on China to be more transparent [about these studies]“, lamented Wendy Rogers, Professor of Clinical Ethics at Macquarie University and author of the study.

This is the first time that this type of study has been carried out. The study concludes that, “as a result, a large body of unethical published research now exists, raising questions of complicity to the extent that the transplant community uses and benefits from the results of this research“. 

For further reading:

UN denounces organ trafficking

Organ transplantation in China – good developments or hidden trafficking?

Fox News, Christopher Carbone (6/02/19) – ‘Barbaric’: Human organs harvested from Chinese prisoners prompts outrage, call for retraction of 400 scientific papers

LaLibre.be (11/02/19) – Des prisonniers chinois exécutés pour… leurs organes

Mohammad, 20, sold his kidney to illegal traders. “I had lost all hope of finding a job and I wanted capital to start a business to help my family,” said the man, who asked to be identified only by his first name. “I was promised $6,000 for my kidney, but I only received $1,250, part of which was spent on post-operative treatment and the rest on paying off my family’s debts. I have nothing left“. Another man, Ihsan Salam, confessed that he had bought a kidney for $15,000 from organ dealers. “I went to Erbil for the transplant because it’s much easier to do it there than in Baghdad and special authorisation from parents is not required, just from the donor and his wife “, he said.

This suggests that “hundreds of Iraqis” have “sold kidneys and other organs through dealers in recent years“. This is due to the war and economic difficulties that force hundreds of desperate citizens to sell their organs to illegal traffickers. According to World Bank statistics, about 22.5% of the Iraqi population were living below the poverty line in 2014. Recent poverty figures are allegedly even higher.

According to a recent report by the United Nations Office on Drugs and Crime (UNODC), the most frequent cases of organ trafficking were reported in the Middle East and sub-Saharan Africa between 2014 and 2016. UN officials have called on governments to do more to fight human trafficking on all fronts. “Domestic trafficking is often neglected and, in some countries, completely ignored […] it is simply not on their radar“, explained Maria Grazia Giammarinaro, United States Special Rapporteur.

The illegal trading of organs in Iraq seems to have got worse since 2016.

For further reading:

UN denounces organ trafficking

10% of transplants around the world are the result of organ trafficking

BioEdge, Xavier Symons (25/01/19)

On Monday, 7 January, the United Nations published a report in which it deplores the fact that human trafficking continues to be a largely unpunished crime, referring in particular to organ trafficking, forced labour and sexual exploitation. It calls for increased international cooperation to pursue criminal networks in countries experiencing situations of armed conflict synonymous with “failure of authorities, forced migration, breakdown of family structures and economic insecurity”.

As regards organ trafficking, 100 cases were reported between 2014 and 2017, more frequently in refugee camps where traffickers recruit their victims “with false promises of money and/or transport to safer places” and bribe health professionals.

For further reading:

• British national who died in Egypt is repatriated without heart or kidneys
• In Egypt, new conviction for organ trafficking
• Organ trafficking will not stop without the help of doctors
• Organ transplantation in China – good developments or hidden trafficking?
• In Romania, organ trafficking is increasing significantly
• Kosovo – doctors convicted for organ trafficking
• 10% of transplants around the world the result of organ trafficking
• Decommissioning of organ trafficking in Pakistan
• Selling organs – the most brutal solution for Syrian refugees in Turkey
• Fight against organ trafficking and transplant tourism: sound proposals

AFP (7/01/2018)